The association of AFP, AST, ALT and Neutrophil to lymphocyte ratio for diagnosis hepatocellular carcinoma

Abstract

Alpha-fetoprotein (AFP) is a tumor marker widely used in the diagnosis and monitoring of hepatocellular carcinoma (HCC). However, it is not applicable to the diagnosis of HCC in all individuals due to the possibility that some liver cancer patients may have AFP levels within the reference range. Elevated levels of AFP have also been found in patients with other liver diseases. Based on this limitation, our study aimed to investigate the combination of routine blood examinations, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), and neutrophil to lymphocyte ratio (NLR), with AFP to increase sensitivity and specificity in diagnosing HCC compared to other liver diseases. This research is a retrospective descriptive study. Data were collected from patients diagnosed with HCC and liver diseases, treated at the National Cancer Institute from January 1, 2019 to December 31, 2022. Results: In total, 203 patients were included, with 96 had HCC and 107 had liver diseases. The area under the ROC curve for HCC diagnosis of AFP, ALT, AST, and NLR were 0.77 (0.72–0.82), 0.70 (0.64–0.76), 0.62 (0.55–0.69), and 0.57 (0.51–0.64) with optimum cut-off values of 20.7 ng/mL, 26 IU/mL, 27 IU/mL and 1.724, respectively. Of all four cut-off values, AST had the highest diagnosing sensitivity for HCC at 83.3%, but with relatively low specificity (57%). AFP had the highest specificity for diagnosing HCC at 98.1%, but the lowest sensitivity at 55.2%. when used together, the combination of AFP and AST showed the highest area under the ROC curve values of 0.74 (0.68-0.79), with sensitivity at 49% and specificity at 98.1%, albeit with reduced sensitivity compared to AFP or AST alone. In patients with AFP levels below 20 ng/mL, AST also showed the maximum area under the ROC curve of 0.67 (0.59-0.75). In conclusion, the HCC diagnostic values of AFP, AST, ALT, and NLR, as well as the combined correlation analyzed from the data, demonstrate that AFP remains a good diagnostic marker for HCC. Although it exhibits relatively low sensitivity, it has very high specificity. AST aids in increasing sensitivity in the diagnosis of HCC.